Objective To assess the safety and acceptability of vaginal hysterectomy with and without simultaneous oophorectomy in a 24-hour day case surgery setting for women with nonprolapse indications for surgery.Design Prospective observational study.Setting A busy teaching hospital and tertiary referral centre for Obstetrics and Gynaecology.Population Seventy-one women from one consultant's practice underwent a vaginal hysterectomy with a planned discharge within 24 hours after the procedure. All women had a body mass index less than 40 and a suitable home environment for routine day case surgery, other than that the women were from an unselected population.Method Prospective observational study.Main outcome measures The duration of the operation and mean blood loss were recorded. Any intraoperative complications were noted. In addition, the proportion of women discharged home within 24 hours of the operation was recorded together with any readmissions to hospital. Returns to theatres and any postoperative complications were also recorded. Postoperative pain scores were assessed 6 and 24 hours after procedure in selected women.Results Seventy-one vaginal hysterectomies were performed as 24-hour day case procedures. The intraoperative complication rate was 1.4%. Sixty-five women were discharged home within 24 hours (91.5%). The readmission rate within this group was 6.2%. The duration of the procedure, mean blood loss, return to theatre rate and incidence of febrile illness were comparable with rates recorded in inpatient studies.Conclusions Vaginal hysterectomy performed as a 24-hour day case procedure appears to be as safe as traditional inpatient management, with a high rate of early discharge and a low rate of readmission. This may have additional advantages for the woman and healthcare provider alike.

Endometrial ablation is a less invasive treatment for menorrhagia than is hysterectomy, and it preserves the uterus. This randomized controlled trial was undertaken to assess 10-year outcomes for 2 established methods of endometrial ablation in 120 women with heavy dysfunctional ablation who were enrolled in the years 1993 to 1995. Sixty-one of them were treated by endometrial coagulation and 59 by endometrial resection. All of these women would have undergone hysterectomy had ablation not been an option. Excluded from the study were women younger than 35 years, those whose uterus was more than twice the normal size or had a cavity depth exceeding 12 cm, and those for whom pelvic pain was a major problem.Only one death, from infection, was related to the initial treatment. Two-thirds of patients had had a single ablation when followed up 2 years after treatment, and the figure after 10 years was 63%. Twenty-six women had had a hysterectomy within 10 years of endometrial ablation. The likelihood of this happening was substantially greater in women less than 40 years of age than in older women (43% vs. 18%). In all, 78% of women had avoided major surgery. The major indications for hysterectomy were bleeding and lower abdominal pain. Only 7% of women still had episodic bleeding 10 years after initial treatment. None of them was more than 45 years of age. On a scale of 0 ("not satisfied") to 100 ("very satisfied"), the overall degree of satisfaction with the outcome of treatment was 84. Nearly 95% of women would recommend the same treatment.The investigators believe that endometrial ablation is an excellent way of treating heavy dysfunctional bleeding. In the present series, if a woman required no further intervention within 2 years of ablation, the chance of having a hysterectomy within 10 years after initial treatment was only 6%. GYNECOLOGY Volume 62, Number 7 OBSTETRICAL AND GYNECOLOGICAL SURVEY ABSTRACTThe first established treatment for anovulatory women having polycystic ovarian syndrome (PCOS) who failed to respond to medical treatment was laparoscopic ovarian wedge resection. Since then, the risk of adhesion formation has prompted the development of less invasive surgical procedures such as ovarian wedge resection by minilaparotomy. This study compared the risk of adhesion formation in 37 anovulatory infertile women with PCOS who had failed to respond to clomiphene citrate and who had ovarian wedge resection by minilaparotomy (group I), and 39 others who underwent laparoscopic ovarian electrodrilling (group II). All participants had a second-look laparoscopy 1 week after the initial procedure. Adhesion formation was assessed using the American Fertility Society classification. The 2 treatment groups were similar demographically and with respect to serum gonadotropin levels.Three women in group II (7.7%) had periovarian adhesions. In contrast, 81% of group I women had periovarian adhesions, and 54% and 46%, respectively, had intra-abdominal and uterine adhesions. Adhesions at all 3 sites were Operative Gyneco...

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Laparoscopic colorectal surgery has become more common with the increase in the number of trained surgeons. We have used a disposable uterine manipulator to retract the uterus. This technique has been found to be very useful for laparoscopic low anterior resection and abdomino-perineal resection in females.